Case Reports

Toric ICL implantation after sequential ICRS implantation and corneal cross-linking in keratoconus: two case report

Case Report Details

First Author: B.Figuerola Garcia SPAIN

Co Author(s):    J. Pérez-Santonja   R. Montes-Micó   S. Aguilar-Córcoles   P. Tañá-Rivero           

Abstract Details

Purpose:

To evaluate the safety and clinical outcomes of Toric Implantable Collamer Lens (TICL) for the treatment of residual refractive errors 12 months after sequential intracorneal ring segments (ICRS) and cross-linking (CXL) in stable keratoconus (KC).

Setting:

Oftalvist Alicante, Spain

Report of Case:

This report shows the outcomes of a 3 steps ICRS-CXL-TICL surgery in 2 patients with keratoconus. TICL implantation was performed at least 12 months after CXL. Visual acuity, refraction and corneal topography were evaluated. A 21-year-old man who has a history of bilateral KC. His Snellen decimal best-corrected visual acuity (BCVA) was 1.0 with a manifest refraction of -0.75D(-0.75Dx180°) in his right eye and -0.50D(-3.75Dx145°) in his left eye. Topographic keratometry (K) values were 44.49-47.14D and 43.17-46.84D, for his right and left eyes, respectively. After ICRS-CXL, his BCVA was 1.0 with a refraction of -1.50D(-1.50Dx35°) and -1.00(-2.25Dx145°). K values were 45.53-44.5D and 45.04-43.84D, for his right and left eyes, respectively. With the KC already stabilized, we considered the implant of a TICL VICM in both eyes, being -3.5D(1.50Dx120°) and -4.0D(2.50Dx66°) with a length 13.2mm for his right and left eye, respectively. After 6 months, uncorrected visual acuity (UCVA) was 1.0 in both eyes with K values of 44.50-45.91D (1.41D of astigmatism) and 44.06-45.59D (1.53D of astigmatism) for his right and left eyes, respectively. A 24-year-old-man was treated by ICRS surgery. After 8 years, the patient complained of blurry vision that was progressively worsening. His BCVA was 0.7 with a manifest refraction of -1.75D(-2.25Dx 65°) in his right eye and -2.00D(-3.00Dx 115°) in his left eye. K values were 47.30-48.50D and 45.90-48.50D, for his right and left eyes, respectively. After CXL, with the KC already stabilized, we decided to give the option of TICL. We implanted a TICL VICM being -4.50D(2.0Dx157°) and -4.0D(3.50x174°) with a length 13.2mm for his right and left eye, respectively. Finally, the UCVA was 1.0 in his right eye and 0.95 in his left eye. K values were 42.65-45.38D (2.73D of astigmatism) and 43.01-46.50D (3.49D of astigmatism) for his right and left eye, respectively.

Conclusion/Take Home Message:

Implantation of TICL following sequential ICRS insertion and CXL is an effective and safe option for correcting high residual refractive error and improving visual acuity in patients with moderate to severe KC in the long term.

Financial Disclosure:

None